激素替代疗法（HRT）对结直肠癌（CRC）死亡率和全因死亡率的影响尚不清楚。我们进行了系统回顾和剂量反应荟萃分析，以确定 HRT 对 CRC 死亡率和全因死亡率的影响。我们检索了 PubMed、Embase 和 Cochrane 图书馆的电子数据库，查找截至 2024 年 1 月发表的所有相关研究，研究 HRT 暴露对 CRC 患者生存率的影响。两名评价者独立提取个体研究数据，并使用纽卡斯尔-渥太华量表评估研究之间的偏倚风险。我们进行了两阶段随机效应剂量反应荟萃分析，以检验 HRT 使用年份与 CRC 死亡率之间可能存在的非线性关系。纳入了 10 项队列研究，涉及 480,628 名个体。 HRT 与 CRC 死亡风险呈负相关（风险比 (HR) = 0.77，95% CI (0.68, 0.87)，I2 = 69.5%，p < 0.05）。七项队列研究的汇总结果显示，HRT 与全因死亡风险之间存在显着关联（HR = 0.71，95% CI（0.54，0.92），I2 = 89.6%，p < 0.05）。线性剂量反应分析（非线性 p = 0.34）显示，HRT 使用每增加一年，结直肠癌的风险就会降低 3%；这种下降非常显着（HR = 0.97，95% CI (0.94, 0.99)，p < 0.05）。额外的线性（非线性 p = 0.88）剂量反应分析显示，HRT 使用每增加一年，全因死亡率风险就会无显着降低。这项研究表明，HRT 的使用与全因死亡率和死亡率成反比。结直肠癌死亡率，从而导致死亡率随着时间的推移显着下降。需要更多研究来证实这种关联。© 2024 中国科克伦中心、四川大学华西医院和 John Wiley

The effect of hormone replacement therapy (HRT) on colorectal cancer (CRC) mortality and all-cause mortality remains unclear. We conducted a systematic review and dose-response meta-analysis to determine the effects of HRT on CRC mortality and all-cause mortality.We searched the electronic databases of PubMed, Embase, and The Cochrane Library for all relevant studies published until January 2024 to investigate the effects of HRT exposure on survival rates for patients with CRC. Two reviewers independently extracted individual study data and evaluated the risk of bias between the studies using the Newcastle‒Ottawa Scale. We performed a two-stage random-effects dose-response meta-analysis to examine a possible nonlinear relationship between the year of HRT use and CRC mortality.Ten cohort studies with 480,628 individuals were included. HRT was inversely associated with the risk of CRC mortality (hazard ratios (HR) = 0.77, 95% CI (0.68, 0.87), I2 = 69.5%, p < 0.05). The pooled results of seven cohort studies revealed a significant association between HRT and the risk of all-cause mortality (HR = 0.71, 95% CI (0.54, 0.92), I2 = 89.6%, p < 0.05). A linear dose-response analysis (p for nonlinearity = 0.34) showed a 3% decrease in the risk of CRC for each additional year of HRT use; this decrease was significant (HR = 0.97, 95% CI (0.94, 0.99), p < 0.05). An additional linear (p for nonlinearity = 0.88) dose-response analysis showed a nonsignificant decrease in the risk of all-cause mortality for each additional year of HRT use.This study suggests that the use of HRT is inversely associated with all-cause and colorectal cancer mortality, thus causing a significant decrease in mortality rates over time. More studies are warranted to confirm this association.© 2024 Chinese Cochrane Center, West China Hospital of Sichuan University and John Wiley & Sons Australia, Ltd.